Many clients come in with stiff upper backs. First, we look to the specific muscles that are hurting. Then we look to the “antagonists” to those muscles. And massage certainly helps.

BUT, as much as I’d like to be able to, I can’t actually work on your back every day. There is, however, something you can do every day to help ease your upper back stiffness. This video is from Z-Health Education:

What to expect in the coming days

When you get a massage or bodywork session, you and your therapist initiate a number of changes in your body.These changes don’t stop happening when you get off the table.Some may take days to finish processing! And the process and its duration varies quite a bit between bodywork styles.

Here are some of the things you may notice in the days following your session:

Soreness. Yes, lets get that out right away.If you’ve received deep tissue work, or a massage with lots of pressure, or had even gentle work done on a very tight area, you may find that you feel a bit stiff or sore the next day. It might feel like you worked out hard, for example.This is normal, and should not last more than a day or so.Whether you are working the muscles via exercise, or we are working the muscles manually through massage, the muscles are being worked — and feel like it later.The best thing to do if you feel this kind of soreness is to move!Even stretch gently.But holding it still will just make things worse in the long run.Drinking water may also help if you’re at all dehydrated ( and in America, many of us are).

Feeling a little foggy.When you first move back into the world after a massage or body work session, you may feel a little foggy.As though you’ve drifted off somewhere and are not really back yet.This is normal.During bodywork sessions, we allow ourselves to stop thinking, stop focusing, and drift.This is actually very good for you, as it helps your mind come back to all sorts of issues from a new perspective.If you find it unnerving, you can stamp your feet – driving your heel into the ground (not too hard).Moving, drinking water, and eating also help.You should feel sharp again fairly quickly.

Dizziness.Massage turns off your fight or flight responses.As you relax deeply, your blood pressure drops.When you first stand up, it make take a moment for your blood pressure to normalize.Just take it slowly at first, and that should clear up fairly quickly.Do ask your therapist for help if you feel unstable. This should not last beyond a few moments. If you feel dizzy the next day, contact your therapist and/or your physician.

A Sense of Tiredness.Many of us push ourselves so hard all of the time, that the only time we allow ourselves to really relax is when we’re going to bed.Then, when we actually just feel relaxed, it feels like tired because we don’t do that other times.Enjoy the relaxation.

Bursting with energy.As we release the places you hold tension in your body, it can be rather like releasing a tightly coiled spring. There was all this potential energy being held (and that itself uses energy).Once it’s released, it’s no longer costing the energy to hold it tight, and things are moving more freely.This is what it’s supposed to feel like most of the time.If you can resist the urge to go paint the ceiling, and instead take it easy for a day or so, you’ll find that your body sort of reacclimatizes to a state in which you just have a little more energy each day.

Feeling Rested.Relaxing in a massage is like taking a nap.Additionally, it helps your body use less energy to hold tight muscles tight.But most of all, it facilitates good sleep. You may find that you fall asleep more easily, or stay asleep better, over the next several days.This will let you wake feeling rested.

Better Sleep.Many people notice that they sleep better in the days following a massage.They find it easier to get to sleep, and easier to stay asleep.This is even more evident in people who get massage regularly.

Clearer Thinking.Allowing our minds to drift, and relax allows them to filter out some of the unnecessary clutter in our thinking.This leaves us with clearer thinking.

Feeling Taller.As we tense our bodies, we contract them, pulling ourselves in.When we relax, and allow the muscles to lengthen, we allow ourselves to return to our full height.

Moving more easily.When your muscles are no longer holding tightly, your joints are free to move more easily.You may notice that your stride lengthens, and that your shoulders move more easily.

Best of all, these wonderful feelings are available to you after almost every massage — frequency does not diminish the benefits!

Leave taking.

Whether your therapist has a one room studio or a larger studio with a reception area, or works in a spa or other larger organization with a reception desk and staff, in the end, you’ll need to re-enter the world, pay for your session, and schedule your next one.

Paying Your Therapist

While many therapists do take credit cards, not all do.You should have checked on this when you made the appointment (and if your therapist is savvy, you should have been warned if they don’t take credit cards at that time.)Just in case, it’s good to have the cash or a check, and not just your credit card.

Therapists rarely allow you to receive your massage and then pay later.Unless you’re using insurance (which most therapists can’t take), or receiving your massage in a medical facility, you’ll be expected to pay at the end of your session.

Discounts

Sometimes, a therapist or spa or studio will offer discounts.They’re lovely if you can get them, but do keep in mind that the therapists profit margin is pretty low.It can be tempting to ask for a discount, but if you do so, you’re essentially telling your therapist that his or her work is not good enough. No one is getting rich working in this job.

If your therapist is an independent owner, he or she has rent, power, heat, laundry, and oils as large recurring expenses. Since this is a physical job, few therapists can maintain a schedule giving eight hours of massage per day.Their take home pay is less than you think.

If your therapist is an independent contractor working for someone else, he or she only gets a portion of the amount you pay.Half is pretty common, and your therapist may still be doing the laundry and providing oils, etc.

If your therapist is working at a chain or spa, he or she is paid even less …. much much less than you pay the spa.

Keep in mind that while your therapist may say that he or she is doing this job “full time” that doesn’t mean 40 hours a week. No one can continue that pace for long. Massage is a unique combination of physical work, mental work, and emotional work. Few therapists take more than 6 clients per day; many take fewer. And no therapist can continue that pace 7 days each week. When the massage day is over, there’s still the notes to write (so we know what we did last time when you return), the laundry to do, other paperwork and clean up.

So, while it’s wholly appropriate to take advantage of discounts or special deals when they’re offered, please don’t try to haggle on the price of your bodywork session.

Tips

Tips are a source of much discussion in the world of massage therapists and body workers.It seems that whether or not a therapist receives tips is tied in some way to where he or she works.Franchise and chain employees really do rely on tips to make their living.Independent contractors and independent owners generally welcome tips, as they too are limited in their income.However, if your therapist is working in a doctor’s office, it may not be expected.

Generally, as with any service position, tips aren’t demanded, but they are very welcome.

You can give your tip in cash directly to the therapist, or add it to your check or charge if using that to pay.

Rescheduling

If you found your massage or bodywork delightful, and why wouldn’t you, you should probably go ahead and schedule your next session.With all of its benefits, it seems silly not to get a regular session. In addition to the therapeutic benefits for injury recovery and over worked muscles, regular massage or bodywork also helps you sleep, boosts your immune system, reduces anxiety and depression, and actually help people think more clearly and be more productive. Massage is healthcare, it’s not a luxury.

Once people find a good therapist, they generally don’t leave, and soon place themselves as regular clients with consistent appointments.This can mean that eventually, the therapist won’t have short term appointments available when you want them.Most good therapists are booked at least two weeks in advance; many are booked three to four weeks in advance; and some are fully booked two months in advance. If you want to see your preferred therapist, get on his or her calendar and stay there!

Also be sure to book well ahead for appointments near the holidays.Many people decide to give gift certificates for massage as Holiday Gifts.This means that those new clients will be filling up the spots unclaimed by regulars.Unless you’ve actually booked your session, the fact that you regularly come on the first and third Tuesday of every month doesn’t mean that your slot will be open if someone else requests it first.

If you are receiving your massage at a spa or franchise or chain establishment, be sure to ask for your specific therapist when you re-book.If you just book a regular session, without requesting your therapist, you may wind up with someone else giving your massage.Additionally, some establishments give their therapists a little bonus for each time that a client requests them specifically.

There are additional benefits to booking ahead. Some therapists even offer discounts for booking ahead.Some offer discounts for booking and paying ahead.Some use loyalty cards, giving you a discount or even a free session after so many (ranging from 6 to 10 in most places).

Thank your therapist, pay with a smile, tip generously if you can, and book your next appointment!

Things that might have happened during your massage.

While some massage styles leaving feeling energized, most leave you feeling very relaxed. During your massage, you have likely allowed your mind to drift into a state of only semi-consciousness, and you may have relaxed enough that you even fall asleep. If so, there is nothing to be embarrassed about (even if you snore, or drool). In fact, as you relax, your body may do a few other things you wish it hadn’t (people burp, drool, fart, sigh…), but you needn’t be embarrassed. These are natural functions, and as your body relaxes, they happen. Often, for example, people find that their stomachs begin to gurgle. I, for one, considered stomach gurgles to be a kind of applause. Massage is all about relaxation — and as you start to allow yourself to relax, your body slips out of its “fight or flight” responses, into the “rest, recover, and digest” mode. And when that happens, your tummy gurgles.

If you happen to be a man, there are other natural body responses to escaping the “fight or flight” response systems. Most massage therapists understand that these responses may well be involuntary. However, what you do about those responses can make a big difference in how your therapist will respond. As long as you can ignore your involuntary erections, so can the therapist.

The end of the Session

When your massage is over, your therapist will give you some verbal cue. Some may say “thank you”; some may say “that’s our time for today”; some may say something else entirely. If you’ve been seeing the same therapist for a while, you’ll note that he or she probably also has a final sequence of a few moves to close the session. In time, your body will know as the session is ending.

When your therapist is sure that you’re awake, and are unlikely to fall when getting off the table, he or she will step out of the room to let you get dressed. Even though your therapist is likely to tell you to take your time, that doesn’t mean it’s okay to settle in for a nap. Unless you are the last client for the day, there is likely another client coming fairly soon after your session ends. This means that your therapist will need to get back into the room to change the sheets and face cradle covers and any pillow cases, and wipe down surfaces, and generally get the room ready. So — don’t rush yourself; take the time you need to get dressed, but do get up and get dressed fairly promptly.

Reconnecting with Yourself

As you come back to the real world, you may even feel a little dizzy or floaty or woozy. This is okay. It just means that you will need to take it easy getting off the table, and move a little slowly. As you begin to walk around, you’ll find yourself settling back into consciousness. Take a little time here too. Notice your body and how it feels. Take a moment to become aware of your feet on the floor; the way your balance might have changed. Move your shoulders, feel how they move differently from when you first lay down. Doing this not only feels good, and lets you be aware of the benefits of your massage, it also helps your body reset it’s “sense” of how tight your muscles should be.

Your mind has also changed. As you relaxed, and let go of the constant stream of thoughts, task-lists, problems, frustrations that run through your mind, you have allowed your mind to reset. Try to be aware of habitual thought patterns – right after a massage is a great time to shift them from focusing on what’s wrong to focusing on what’s right and working. And shifting your perspective can actually shift how the whole day goes.

Debriefing, sort of.

After your session, your therapist may talk to you about what happened during your session. He or she will be checking to make sure that you got the relief you needed for problem areas, and whether there is anything you’d like to address in your next session. Your therapist may also make some recommendations for things that can help you avoid future pain (not all therapists do). This could include exercise, postural habit changes, suggestions on how to make your desk more ergonomic, or simple reminders that sitting in the same position all day long is hard on your body. These conversations should happen somewhere private — either in the treatment room, or elsewhere that no one is likely to just wander into the conversation.

Many therapists offer their clients water after their sessions. There are a variety of truths and myths surrounding why — but folks do tend to feel a little dehydrated after a session. Your therapist may leave water in the room for you, or may wait outside the door with it, or may meet you at the front desk with some. Hydration is generally a good idea. It can also help you feel more aware and awake, so if you are feeling light headed, drink the water!!.

Looking Back: Part I: Booking an Appointment,Part II: the Health History FormPart III: Privacy, and What to Tell Your TherapistPart IV: Getting on the TablePart V: This is YOUR MassagePart VI: On the Table

Can you believe there was this much to say before we got to the part where your therapist actually touches you? Me either! But then again, most folks don’t realize quite how much goes into becoming a massage therapist either. We’ll take that up another time. (If you’re new to the series, you can find the first entry here.)

Here we are. You are lying under the sheet on the massage table. Your face is nestled into the face cradle, and you have asked your therapist to adjust it so you are perfectly comfortable. You’re warm enough, and well bolstered. The music is playing in the background….

Finally, your therapist is ready to begin your massage!

No Two Massages are the Same

First off, let me tell you that no two therapists do exactly the same massage. Even if they’re from the same school. Even the same class. Even if they actually choreographed the movements.

How can that be? Part of it is because massage isn’t like a dance routine. It’s an interactive art, in which both the therapist and the recipient play a role. And that means that, since no two people are truly the same, the way any two massage therapists respond in a given movement will be slightly different. Each therapist is an individual person with different sensibilities, awarenesses, motives, and abilities. We each have our own body structures, strengths, weaknesses, and our own personalities. We will interpret massage differently.

Part of it is because no recipient is exactly the same. People come in all shapes and sizes. Even if they’re equipped with the same muscles, they’re not all the same length or strength and they hold their tension in different places.

You aren’t even the same person you were yesterday. You have slightly different tensions today. Your mood is different. Your workload is different. So, your body is different. This, by the way, means that even if your massage therapist were able to provide a cookie cutter massage, doing exactly the same thing each time, it would feel slightly different to you.

So how can I possibly tell you exactly what will happen while you’re on the massage table?? I can’t. But I can point out things that ought to be consistent.

The Table

As you got onto the table, you should have found that it is at least slightly cushiony, and has been dressed with clean sheets – top and bottom. You may find that it also has a blanket over the sheet. The face cradle should also be covered with a pillow case or specialized cover. Some tables have table warmers. This makes the table itself warm. If it’s too warm, your therapist should turn it down or off for you. When you’ve settled in under the covers, you should not feel hot or chilly.

The Ambience

While every therapist’s room is likely to be a little bit different, you are likely to find that most have music playing. Typically, it’s relaxing music, often without discernible beats. However, many therapists will play whatever you like if you have requests for the next session. Some people enjoy listening to rock and roll, others prefer classical. And some prefer silence.

Unless you’re in a physical therapist’s office, the lighting is likely to be fairly low in the treatment room. It should be relaxing, not dark.

The Temperature

Clearly, the room temperature should be such that you are not chilled while receiving your massage. However, the temperature should also be such that your therapist doesn’t over-heat while giving the massage. There is a fine interplay, and sometimes that means that your therapist will have a small fan on to keep the air moving, or blowing on his or her feet to help keep cool without chilling you. Sometimes, there will be a small heater in the room as well, so that the room can be warmed up for you when you arrive.

If you find the room too cold or too hot, please tell your therapist. Adjustments can often be made, either to the room temperature, or to the table temperature.

Draping

In Illinois, and in most other states, there are actually laws about the ways in which your body must be covered during a massage. Typically, if you are receiving a Swedish Massage, or any other type of massage in which you’re asked to disrobe, you will be covered by a sheet. In some instances, you may be covered by a large towel. Either way, your body will be covered.

During the course of your massage, your therapist will remove the drape from whatever area he or she is working on, and recover that part of your body when he or she has finished working there.*

If you have abdominal work done, your therapist will add another drape to cover your chest, and then pull the regular drape down to expose your abdomen.

While your therapist may leave your back undraped while working on your arms, or drape you so that much of your back and one leg is exposed, typically, your back will be covered once your therapist is finished working on it. If at any time you find that you are cold, you can ask to be covered more.

There really are laws about draping. That means that if you find that you are too warm, there is only so much we can allow to be uncovered.

Pillows and Bolsters

While there are indeed some modalities in which you will lie on a table with no pillows or bolsters, your typical massage will include their use. Since many massage therapists start their basic massages with the client lying on their stomachs, I’ll start with the face cradle.

As you can see, the person receiving the massage has her face in/on a special pillow with a hole in the center where your face should fit comfortably. We use these so that your neck isn’t twisted during the massage, and so that we can work on your upper back and neck while they are in alignment without smashing your nose into the table. If you see one on the table when you come in, you’re likely to start the massage face down, with your face in the cradle.

We also use a number of other bolsters to help make you more comfortable on the table. Among these are bolsters that we slide under your ankles when you’re lying prone (face down) or under your knees when you’re lying supine (face up).*- In both cases, they ease strain on your back, and generally make it more comfortable to be lying flat for a long time.

Sometimes, you may be asked to lie on your side. In those cases, we use a number of pillows and bolsters to cradle and support you so that you can fully relax while we work.*4

The side lying position is commonly used for pre-natal massage, but can also be wonderful for helping to resolve a number of restrictions to movement.

Sometimes, we’ll use a pillow under you to make you more comfortable.

Oils and Lotions

Generally, if you are receiving a massage that involved you getting undressed, your therapist will be using an oil, gel or lotion to allow his or her hands to move smoothly over your skin. **

Depending on your therapist, you oils may be scrupulously scent free, or they may have essential oils blended in to enhance your session. Some oils are thicker than others. Most absorb into your skin during the course of the massage, so unless your therapist is using a very thick oil, you should not feel slimy after your session.

If you have any allergies or aversions to scents, please be sure to tell your therapist. You shouldn’t have to tell your therapist more than once or twice.

I, for example, have a client who really hates lavender. I don’t recall without checking whether she is actually allergic to it, but that doesn’t really matter — she hates it. Therefore, even if I’ve used lavender in other sessions that day, I make sure that the room doesn’t smell of lavender when she arrives, and I never use an oil that has lavender in it on her body.

What does “Full Body” mean?

Unless you’re going in for a therapeutic massage to address a specific issue, in which case your therapist may spend your entire session working just on muscles that address that issue, you’re likely to be receiving a full body massage. Yes, that really does mean that your therapist will massage almost all of your body. There are about 640 muscles in your body. I won’t be listing them all, but you’ll have a large fraction of them worked on during a full body massage. In future issues, I’ll address why we work on certain areas of your body, and the benefits that doing so can have on the rest of your body. For now, I’ll just address what we will and won’t touch during a typical session.

First off, if its is typically covered by a thong bikini (on men or women), we won’t be touching it.

If you are uncomfortable with any of these, pleasespeak up and ask your therapist not to work in those areas. However, as you’ll see in future posts, each of those area is worked for a reason. Ignoring your glutes when you have back pain can mean that your therapist can’t fully resolve the issues.

In almost all cases, the touch should be soothing, and relaxing, not painful. And you should feel discomfort only when your therapist is working on a problem spot, and you’ve discussed how much discomfort is okay.

Talking During the Massage

Your therapist should let you take the lead in choosing whether or not to engage in conversation during your session. Some people really like to talk during a massage. Others really relish the silence, and the ease of not having to engage their minds with conversation. While that’s true for everyone, in this situation, the therapist should accommodate your preferences. You should feel no obligation to fill the empty space with conversation.

That being said, your therapist should ask you for feedback about pressure, intensity, and comfort from time to time. If your back can take a lot of pressure, but your calves are tender, the only way to be sure your therapist knows is to tell them.

That’s more than enough for today. Relax, sink into the table, and enjoy your massage.

You’ve scheduled your appointment, arrived on time, completed your health history form (including all sorts of things you still don’t quite understand the relevance of), you’ve told your therapist the big things, and your goals for the session, and you’ve gotten undressed and slipped in between the sheets on the massage table.

And yes, there remain a few things to think about —

This is your massage.

This is your massage. It’s not the therapist’s massage. It’s not mine. It’s yours. You are paying for a service that ought to be tailored to you and your needs. And the only way we can do that is if you speak up. It’s weird, but this can be hard — even for other massage therapists. There’s a funny thing about putting yourself in a therapist’s hands that tells you not to complain — don’t listen to that inner voice. Ask for what you need.

If you are not comfortable, in any way, tell your therapist.

If you are cold, ask for another blanket.

If you are hot, ask if the blanket can go, or the table warmer can be turned off or down, or if your therapist has a fan (the sheet cannot go).

If you need a bolster or pillow anywhere, ask for one. Some places one might like a bolster include:

Under your knees or ankles.

Under your shoulders when you’re lying face down.

Under your neck when you’re lying face up.

Under your belly.

Under your arms.

Between your knees if you’re side lying.

If anything your therapist does hurts, say so. And repeat that, if he or she doesn’t immediately change what he or she is doing. Unless you have negotiated with your therapist that a certain therapeutic treatment will hurt, and you’ve explicitly agreed to an amount of pain, massage should not hurt.

If you feel even remotely uncomfortable with what your therapist is doing, say so. If you hate having your feet touched, you don’t have to have your feet touched. If you thought that glute work was a good idea, but once your therapist started doing it, you decided you don’t want or like it — tell your therapist to stop.

If your therapist is using too much pressure, don’t be stoic about it — complain! Ask them to lighten up!

If your therapist isn’t using enough pressure, don’t lie there feeling like you’re just getting a nice moisturizing session, ask for more pressure.

If your therapist is chattering away trying to converse with you, and you really wanted quiet — say so. “I’d really like to have a quiet time during this massage”

If your therapist is completely silent and you prefer to have some conversation — ask a question.

There are Limits …

There are some requests that we cannot accommodate. Licensed Massage Therapists are governed by State Licensing Boards. And those Boards do what government does best: write regulations. The regulations in question are there, in this case, for your safety and that of your Massage Therapist.

In most states, we cannot allow you to be fully uncovered on the table. There must be draping of some kind. Please do not ask to completely remove the drape (sheet).

In all states, we cannot participate in any kind of sexual interaction with our clients. Never in the course of a massage. And … even when we’re off duty, we can lose our license if we develop a sexual relationship with a client. So please, don’t ask.

We can’t diagnose your condition. We can’t prescribe things. Unless your therapist also carries a license to do those things, it’s illegal for him or her to try. Please don’t ask us to do that.

And, there are some requests and behaviors we will not ever tolerate. Furthermore, you shouldn’t tolerate them either!

Inappropriate touching. Your therapist should never touch your genitals or your nipples. You should never touch any part of you therapist that is ordinarily covered by a modest swim suit (two piece for women). While accidental grazing can occur — intentional touching of this kind is absolutely prohibited. If either party engages in intentional inappropriate touching, the massage should be ended immediately. If the person doing the touching is you, the client, you’ll still owe for a complete massage. If the person doing the intentional inappropriate touching is the therapist, you will not owe for the massage, and you should report the incident to the manager of the establishment, as well as the state massage licensing board.

Inappropriate and suggestive language. Just as neither party should be touching, neither party should be discussing sexually related things.

Outright requests for sexual activities. These will terminate your session, and likely get you banned from the establishment and reported to the police. If your therapist does it, end the session, report the therapist to management, the licensing board, and the police. Solicitation is never okay.

Tell your therapist all of the things that are troubling your body (they might be related, they might not).

Remind your therapist about hearing issues and allergies to things that might be in the oil.

It feels like a lot has gone on,and you’re not even on the table yet! Don’t worry. All of this stuff actually takes very little time. Some of your therapists can email you the intake form before you even arrive. And that interview we talked about in my last post? Usually takes only a couple of minutes unless there is something serious going on. But, finally, we get to the part where your therapist has brought you to the space in which you’ll get your massage or bodywork session!

You may have already arrived in this space to have your pre-session interview, or you may now be arriving. Your therapist will first go over what specific areas you would like to have work done on.

Tell your therapist all that’s bothering you!

It’s so very easy to forget things. But your therapist really does need to know that you bruised your shin before starting to work on you. Why? Well, sometimes, we reach under your body to work. If we don’t know there’s a bruise, we’ll not be able to moderate our touch to avoid hurting it!

Even if you have a primary complaint (your shoulders are trying to make love with your ears, and your neck is objecting), it’s probably true that something else has been twingey. Unless you’re having a truly focused session, in which your therapist is working ONLY on that issue, your therapist is going to want to know which areas will need the most time so that he or she can allocate the time to be able to give your full massage. If you don’t mention that your quads are tight too, there won’t really be enough time to address that before the session is over by the time your therapist gets to them!

Please wait to undress!

For many types of massage, we ask our clients to undress and get on the table between the sheets. In many states, Illinois being one, we risk our licenses by being in the room with you when you’re getting undressed. Even if you are completely comfortable with your body (and yay for that!!), and with it being seen in all its glory by your therapist, please, wait until your therapist steps out the door before disrobing.

If you need help getting undressed, we are limited to some degree in how much help we can give. As long as there is a tee shirt or cami or bra under your shirt, I can certainly help you unbutton it if your hands won’t do that. And I can unzip the back of your dress. I cannot help with zippers on pants. And except for outer sweaters, I can’t actually remove clothing for you. If you do need that much help, you can have a caregiver or family member come to help you get undressed and on the table. (They will be able to wait outside the massage room during your session).

How far to undress?

If you’re going for a “standard” full body massage, we typically ask you to get undressed “to your comfort level”. What on earth does that mean? That means that while we generally prefer to find that you are completely naked under the sheet (no clothes, no underwear, no jewelry, no watches), we understand that you may not be comfortable with that. If you feel more comfortable leaving your underwear on, that’s fine. We can work around that.

HOWEVER, there are some kinds of work that can’t be done as well or as effectively without skin to skin contact. If, for example, you are having trouble with your hamstrings and low back, your therapist will likely want to work on your gluteal muscles.* Working through the sheet (and your underwear) is possible, but some work is more effective if your therapist can actually get to your skin.

Similarly, it’s hard to work on back muscles through a bra strap.

How exactly should I be on the table?

Typically, you will either lie down face up, or face down with your face in a face cradle. Your therapist will generally tell you, but if you see a face cradle and your therapist hasn’t said anything one way or the other, lie face down, with your face in it. You will lie down on top of one sheet, with another sheet (and possibly a blanket) over you.**

Your therapist will give you time to get undressed and onto the table. Generally, your therapist will knock, and ask if you’re ready. If you aren’t yet, that’s perfectly fine! Simply say “not yet” and your therapist will give you more time. Some people are eager, and manage to get fully undressed, with jewelry off, and onto the table in about 20 seconds. Most take longer, and if you are in pain, undressing alone can be a challenge. We understand.

Be sure that you are comfortable

If you find that you are cold, please tell your therapist as soon as he or she steps back into the room. Some therapists have table warmers that can be turned on or up, some have heaters, some have piles of blankets, some have all of these things. Muscles respond better when they’re warm.

If you find that you are hot, please tell your therapist! Table warmers can be turned off. Blankets can be removed. (Sheets, however, cannot. Most state laws require full draping). Many therapists also have fans in the room to stir and cool the air.

If the face cradle is too high or too low, please tell your therapist. Most can be adjusted.

If you need a bolster or pillow under your shoulders, or under your belly, please tell your therapist. Comfort is very important! Most therapists offer a bolster under your ankles. If you do not want one, please say so. If you’d like a higher or lower one, it’s okay to ask (not all therapists will have a variety, but many do).

And, most importantly — you can and should make these issues known at any time during the session!

In our last “issue“, we discussed some of the many reasons why your massage therapist asks you to complete a health history form. At the end of that, I acknowledged that some of you may be worried about the privacy of your confidential medical information.

Privacy

As healthcare professional, we observe many of the same practices as any other healthcare professional. We know that your information must stay secure for you to be able to feel safe providing the information we need to do our best work.

Therapists who adhere to the standards set by any of the Associations for massage therapists keep your records in confidential files. We keep those files in secure file cabinets. In order for us to share these records with anyone, including your doctor, we need written permission from you!

Confidentiality

Confidentiality is a lot like privacy. Most of us follow the same guidelines that your doctor, psychotherapist, or lawyer follow: Whatever you tell us in the course of our sessions is held to be confidential. We will not disclose that information to anyone without your express written permission. In short, “What you say in here, stays in here.”

That means that if we are working with you in cooperation with your doctor or your physical therapist, or other medical professional, you will need to sign a form to allow us to discuss your sessions with them. Even if you were referred to a massage therapist by a doctor, we’ll still need your express permission to tell him anything!

Many of us act as though we are already governed by HIPAA regulations. Under HIPAA, we aren’t even allowed to acknowledge that you’re our client without your permission.

What to tell your therapist

Once you’ve filled out your forms, or when you arrive if this you’re coming back, you therapist will likely want to talk to you about what is going on with you, and what you’re looking for that day. This conversation may happen in an ante-room, or in the treatment room itself. (note, this is not the time to start undressing). In either case, it will happen where you and the therapist cannot be overheard.

The more specific you can be, the better. But don’t hesitate to tell your therapist anything that might be relevant. This is one of those places where extra information is unlikely to hurt anything, but not enough information could cause problems.

If you have an allergy to anything that might be used in a massage oil, please remind your therapist at your first visit and at your second, even though it should also be on your intake form. By your third visit, your therapist should know.

Changes to your medical history. If something has changed since the last time you filled out the huge ungainly form, say so. If you’ve had an injury, illness, or changed medications, that will be important information for your therapist.

How you experienced the work that you and the therapist did the last time you were there. If your therapist did focus work on your shoulder, report on how that worked out, and how your shoulder is today.

What’s troubling you today.

Physically: if something hurts, or you are finding that you’re stiff, or don’t have full range of motion, tell your therapist. Even if its not the main reason you’re there. You’ll be amazed at how many parts of your body are connected in ways you didn’t know about. (Sometimes, shoulder pain starts at the opposite hip, for example).

Mentally: if you’re under a lot of stress at work, or having a hard time focusing, or finding your mind racing through a myriad of thoughts when you’re trying to sleep, your body also suffers. There are certain styles of massage that can help this.

Emotionally: again, if you’re under stress at home, with relationships, or any other reason, this affects your body. There are types of bodywork that can help you.

Mental/Emotional Health: if you’re suffering depression, or anxiety, let your therapist know. It will change the way he or she structures your sessions — and will allow yourself another opportunity to heal

If you have something right after your session, and time or appearance is an issue:

If you have an interview, or business meeting, you may want to alert your therapist not to mess up your hair more than necessary. Or ask him or her not to work on your face.

If you really need to get somewhere quickly after your session, let your therapist know. You can relax more easily knowing that someone else is watching the clock. Also, your therapist can adapt the ending of your session to help bring you back to full alertness more quickly.

If you’re ticklish. Sometimes, ticklishness is actually a sign of very tight muscles. Sometimes it’s a sign of sensitive skin. If your therapist knows that you have a ticklish zone, it is possible to adapt the approach to that area to avoid the ticklish response.

If you have areas you specifically do or don’t want to have worked on.

If you feel very uncomfortable with someone touching your abdomen, tell your therapist. Many massage styles include abdominal work. But one of a Licensed Massage Therapist’s first rules is that we touch only with permission. Just because you choose to get a massage doesn’t mean you’ve given anyone carte blanche to touch you where you don’t want to be touched.

If you feel uncomfortable about having someone touch your glutes (your bum), say so. It is likely that your therapist will want to work your glutes if you have leg or back issues, because those really are large muscles that have a lot of far reaching impact. Even so, it’s your body, and you can say no.

If you have a particularly troublesome area, please tell your therapist and ask for extra attention there!

What you’re looking for out of this session. I ask my clients “How do you want to feel when you leave today?” Its surprising how hard that question really is. But if you’ve reported reduced range of motion in your shoulder, but really just want to feel mellow and relaxed, your therapist may spend more time resolving the shoulder issue than you’d like.

Finally, please!!! ask any questions you may have! It may not be the time to have a discussion about who to vote for in the next city council election, but if you have questions about massage or bodywork, this is a great time to ask.

Your first visit – what to expect and why.

When you arrive for your first visit with a new-to-you therapist (or at a new-to-you clinic), you should be asked to fill out a health history form. If you’re not, you might want to ask why not! Massage therapy is health care. Even if you’re just going for a relaxing, zone out session, you are inviting someone to work with your body; it just makes sense to let them know what your body’s condition is. When you come back another time, your therapist will rely on the information on that form.

Why do I have to fill out a health history form??

And why do you care about surgeries and injuries from ten years ago??

For your safety!

There are a number of medical conditions for which certain types of massage are contraindications (that means that you shouldn’t get that type of massage), or for which adaptations must be made for your safety.

If you have congestive heart failure, you should have clearance from your doctor before you get Swedish massage or any other type of massage that may increase your blood flow.

If you have certain kidney diseases, massage that increases blood and lymph flow could put an unsafe burden on your kidneys.

If you have a pacemaker, there are certain adaptations that your therapist must make.

If you are pregnant, there are adaptations that must be made, especially in later months, to keep your circulation moving, and do avoid undue pressure on the baby.

If you have high-blood pressure, your massage therapist needs to be aware. Even when your hypertension is controlled by medication, you are more likely to get dizzy when getting up from the table.

There are many more – which is why your massage therapist took an entire semester on pathology as it relates to massage.

There are a number of medical conditions for which certain types of massage are locally contraindicated (that means that you can get a massage as long as the therapist doesn’t touch specific areas).

If you have ring worm or other fungal skin infection, your massage therapist must be careful not to touch it (lest it spread on your body).

If you have poison ivy, or other contact dermatitis response, massage will just spread the problem. The therapist can massage the rest of you, but not where your skin is affected.

If you have a recently sprained or broken limb, the massage therapist should not work with it until the initial inflammation has gone down.

If you have pitting edema (swollen limbs, which, when you push against the skin doesn’t bounce back right away), the massage therapist should only work above that area. Pitting edema can be a sign of other serious medical conditions, so your therapist may ask for a doctor’s note before you can return.

Again, there are many others.

There are a number of prescription and over the counter medications that require your therapist to change his or her approach.

If you are taking a pain killer of any kind, be sure to let your therapist know! When you’re on pain killers, even tylenol, your ability to discern when something is hurting you is diminished.

If you are taking a muscle relaxant, you should let your therapist know. The drug will change the way muscle tissue responds.

If you are taking medication for mental health issues, you may react differently to stimulus. The therapist needs to know so that he or she will know what to watch for.

For your comfort.

If you have a sinus infection, you will be much more comfortable if you spend more of your time supine (lying on your back) than lying prone with your head in a face cradle that puts pressure on your sinuses.

If you suffer from migraines, you may be more comfortable with dimmer lights and quieter or even no music.

If you have chronic low back pain, your therapist may be able to add bolsters to ease pressure on the back while working to also ease the muscles that are causing it.

If you have steel rods, pins, screws, or plates, the massage therapist should know so that he or she adapts the pressure around them.

For the therapists’ safety.

If you have an infectious illness or disease, you should not receive massage. You risk infecting the therapist, and in fact any clients he or she sees later in the day.

If you have a mildly infectious disease, that is only transmissible in certain ways, your therapist can take appropriate precautions, and avoid the risk of being infected or infecting others.

If you suffer from PTSD but don’t tell the therapist, he or she may do something that triggers a strong response without knowing it. On the other hand, if you explain that you suffer from it, and what triggers you, your therapist can work in ways that are safer for both of you.

Again, there are others.

To improve your treatment outcome.

Even old injuries leave traces in your musculature. If you sprained your ankle four years ago, you probably limped. You changed your gate to favor the injured ankle, and in so doing worked the other side of your body more. Its probable that you never actually restored your gate 100%, which means that one side of your body is still working harder. If your therapist knows this, he or she will know where to look to find the imbalance and help treat it.

Old surgeries also leave traces. Scar tissue decreases the ability of nearby tissues to move. Not a lot, but enough to note. If your therapist knows about your surgeries, he or she may be able to ease some of the long held adhesions and restrictions to give you fuller range of motion.

If you don’t answer all the questions on your form, your therapist won’t have information he or she needs to plan an effective course of treatment for you.

But what about my privacy??

How Does This All Work,
or What are the Unspoken Rules??- Part 1

When you go to get a massage, there’s a kind of etiquette involved in the whole thing. Etiquette? Seriously? Actually – yes. It’s a way that you treat the massage therapist, and that the massage therapist treats you.

Just like there are socially acceptable ways to behave at the dinner table (which change when you get to tables with tablecloths and white napkins), there are appropriate and inappropriate ways to behave when giving or receiving massage.

No matter how many massages you’ve received, there was a time when you went for your first massage. You placed that first phone call to schedule a session, and wondered “how does this work, anyway?” I thought I’d share some insight from the therapist’s side of that question. I hope it will make that first session easier for any one who has either not received a massage recently (why ever not??), or who has not yet discovered the wonder of bodywork.

Some of these things seem obvious to many people. Some may seem so obvious to you that you wonder why I’m wasting bandwidth on them (it’s because I’ve seen the issue as a problem at some point, so yes, this really happens). Furthermore, many of these things also apply to almost anyone whose services you use (doctors, dentists, physical therapists, hair stylists, lawyers, CPAs…. anyone with whom you make an appointment). Others are more specifically related to massage therapy.

Making Your Appointment

While every therapist or spa or clinic has it’s own way of doing things, some are pretty universal.

When you call, if you get a voice mail, please do leave a message. Many times your therapists handle scheduling ourselves, and cannot answer the phone while we are in session. If you don’t leave a message, we don’t know who to call back. You’ll just miss out on a great massage …

Please be sure to provide your name, phone number and or email at the time of booking. If something happens that requires changing your therapist’s schedule, we want to be able to reach you!

Try to schedule your session at least a week in advance. Sure,discovering that your therapist of choice has no same day appointments can be frustrating, but it’s just as frustrating to be unable to get you into the schedule because there’s no lead tim. A full schedule is likely to mean that your therapist is good at what he or she does, and thus has regular clients who book ahead. Since few of us do this just for fun, we actually can’t afford to allow huge holes in our schedules just in case someone calls at the last minute.

When you put your session in your calendar, you should block out enough time to arrive, possibly fill out paperwork, have a brief discussion with your therapist, undress, get on the table, receive your full session time, rest a moment, get up, get dressed, pay for your session, and rebook for your next session. You simply can’t complete an hour massage and take all the other steps in only one hour. Give yourself time after the session to enjoy feeling relaxed before you have to do the next thing.

For your first appointment, expect to fill out paperwork when you get there. We’ll get into this a bit more later, but be aware that since massage is healthcare, your therapist will need to know some of your medical history, and to know what is going on with you. So, give yourself some extra time to fill that out.

Before you hang up, verify the form of payment that your therapist accepts! No one will be offended if you ask whether they take credit cards, but everyone will be embarrassed if that’s all you take to pay for a session with a therapist who can’t take them!

Keep your Appointment!!

When you schedule your appointment, your therapist sets aside time for you and holds it. That means that not only can therapists not book anyone else at that time, they can’t book someone at the half- hour before. They’re holding at least an hour and fifteen minutes, if not an hour and a half just for you. They’re counting on you to come.

If you have to miss your appointment, please, give your therapist as much notice as possible. Most folks have a 24 hour cancellation policy. With 24 hours, they have a chance of filling the slot (especially if they have a waiting list), and thus not losing money on your schedule change. Unless it’s an emergency, you should expect to pay for your session if you cancel last minute.

Arriving for Your Appointment

Please arrive on time — even a few minutes early. If you’re late to your session, your therapist may not be able to extend your time past the originally scheduled end-time for your session. If there are clients after you, their scheduled appointment has to start on time, which means your session can’t run over. If you’re right on time, or a few minutes early, you’ll have time to go to the rest room, explain your current issues to your therapist, and get undressed and on the table while he or she steps out to wash his or her hands.

If you’re late to your session, you don’t get a discount because your massage was cut short. Your therapist was ready and waiting for you. It is unfair to dock someone else’s pay because you got delayed.

BUT – don’t come too early. If you’re too early, you will find that your therapist still has someone either on the table, or still in the session room getting dressed. You’ll need to wait while your therapist handles the check out (receiving payment, explaining what to do to avoid future pain, rebooking the appointment), and then continue while he or she cleans the room and re-dresses the table for your session. Your therapist will feel rushed, and you’ll feel impatient.

Please arrive clean. This should go without saying, but please don’t spend the morning working in the garden, getting dirty and sweaty, and then go straight to your massage therapist before showering. In the summer time, please pause on your way and check to see whether the soles of your feet are black with grime from walking barefoot (or in sandals that get all that dirt in them). *
Bathing, or washing your feet, show respect for both you and the therapist. And, it prevents the dirt from being inadvertently spread further around your body. (Remember, many therapists work your face last — which means after your feet.)

Finally, please be sure to bring with you the appropriate form of payment. Nothing is as frustrating for either of you as ending a session and not having the cash or check to pay for the session only to learn that your therapist can’t accept credit cards.

In Part II, we will cover what to do once you’ve actually gotten in the door.